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   2016| July-August  | Volume 29 | Issue 4  
    Online since December 16, 2016

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Autologous stem cell transplantation for multiple myeloma: Long-term results
Lalit Kumar, Rakesh Reddy Boya, Rohit Pai, P Harish, Anjali Mookerjee, B Sainath, Mukesh Bhimrao Patekar, Ranjit Kumar Sahoo, Prabhat Singh Malik, OD Sharma, Ritu Gupta
July-August 2016, 29(4):192-199
Background. Survival of myeloma patients has improved considerably in the past decade. However, limited data are available on their long-term outcome. We analysed the data of 225 consecutive patients who underwent autologous stem cell transplantation (ASCT) at our centre. Methods. Between April 1990 and December 2013, a total of 225 patients with multiple myeloma (median age 53 years, range 27-67 years, 69.3% men) underwent ASCT. High-dose melphalan 200 mg/m2 was used for conditioning. Before transplant, the patients received induction therapy with novel agents (thalidomide and dexamethasone, or lenalidomide and dexamethasone, or bortezomib and dexamethasone); or vincristine, doxorubicin, dexamethasone; or alkylating agents (vincristine, melphalan, cyclophosphamide and prednisolone; or melphalan and prednisolone). The response to transplant was evaluated using the European Bone Marrow Transplant criteria, and an intention-to-treat analysis was done. Results. Four-fifths (79.6%) of our patients had Durie Salmon Stage (DSS) IIIA and nearly a quarter (24%) of them had International Stage III disease. Before the transplant, 80.4% of patients had chemosensitive disease. The median interval from diagnosis to transplant was 10 months (range 2-128 months). Following ASCT, 197 (87.5%) patients responded. Complete response was obtained in 54.7%, very good partial response in 19% and partial response in 13.8%. At a median follow-up of 90 months (range 18-266 months), the median progression-free survival (PFS) and overall survival (OS) were 32 and 85.5 months, respectively. The estimated PFS and OS at 10 years were 29.7% and 43.6%, respectively. On multivariate analysis, the presence of extramedullary disease (HR 3.05, p < 0.001), and ISS III (HR 0.50, p < 0.02) predicted inferior OS. Extramedullary disease at diagnosis (HR 1.585, p < 0.03), and more than one regimen pre- transplant (HR 0.53, p < 0.02) predicted an inferior PFS. Complete response was a predictor of superior OS and PFS (p < 0.001). Conclusion. Complete response following ASCT is associated with good long-term outcome. Alternative treatment strategies are needed to improve results in patients who fail to achieve CR post-transplant and in those with high-risk disease.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,740 850 -
Retaining health workforce in rural and underserved areas of India: What works and what doesn't? A critical interpretative synthesis
Sonu Goel, Federica Angeli, Nidhi Bhatnagar, Neetu Singla, Manoj Grover, Hans Maarse
July-August 2016, 29(4):212-218
Background. Human resource for health is critical in quality healthcare delivery. India, with a large rural population (68.8%), needs to urgently bridge the gaps in health workforce deployment between urban and rural areas. Methods. We did a critical interpretative synthesis of the existing literature by using a predefined selection criteria to assess relevant manuscripts to identify the reasons for retaining the health workforce in rural and underserved areas. We discuss different strategies for retention of health workforce in rural areas on the basis of four major retention interventions, viz. education, regulation, financial incentives, and personal and professional support recommended by WHO in 2010. This review focuses on the English-language material published during 2005-14 on human resources in health across low- and middle-income countries. Results. Healthcare in India is delivered through a diverse set of providers. Inequity exists in health manpower distribution across states, area (urban-rural), gender and category of health personnel. India is deficient in health system development and financing where health workforce education and training occupy a low priority. Poor governance, insufficient salary and allowances, along with inability of employers to provide safe, satisfying and rewarding work conditions-are causing health worker attrition in rural India. The review suggests that the retention of health workers in rural areas can be ensured by multiplicity of interventions such as medical schools in rural areas, rural orientation of medical education, introducing compulsory rural service in lieu of incentives providing better pay packages and special allowances, and providing better living and working conditions in rural areas. Conclusions. A complex interplay of factors that impact on attraction and retention of health workforce necessitates bundling of interventions. In low-income countries, evidence- based strategies are needed to ensure context-specific, field- tested and cost-effective solutions to various existing problems. To ensure retention these strategies must be integrated with effective human resource management policies and rural orientation of the medical education system.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,463 773 -
Anaemia in adolescent girls: An intervention of diet editing and counselling
Andezhath K Susheela, Rashmi Gupta, Nisith K Mondal
July-August 2016, 29(4):200-204
Background. Though a major public health problem of nutritional anaemia in schoolchildren is being addressed by iron supplementation and/or fortified food, they continue to be anaemic. We aimed to study the effect of fluoride consumption on haemoglobin levels and whether elimination of fluoride from the diet would correct anaemia in children. Methods. Two hundred and fifty adolescent girls, 10-17 years of age, from a government senior secondary girls school in East Delhi, participated in the programme. Only those girls who were dewormed in the school health programme and not on any medication particularly for malaria, were included. The investigations done were (i) haemoglobin level; (ii) fluoride content in urine; and (iii) fluoride content in drinking water both at home and in school. The anaemic students consuming safe drinking water with fluoride level <1.0 mg/L and with urine fluoride >1.0 mg/L were introduced to interventions, viz. diet editing and diet counselling when parents came for the monthly parent-teacher meeting. Besides the parents, their wards and class teachers also attended the counselling session. The students were monitored by re-testing haemoglobin and urine fluoride levels at 1, 3 and 6 months after the start of the intervention. Results. There was an inverse relationship in the levels of urine fluoride and haemoglobin. Reduction in the level of urine fluoride led to a rise in the haemoglobin level. Following interventions, the haemoglobin level revealed significant improvement from the anaemic (<12.0 g/dl) to the non- anaemic range (12.0-14.4 g/dl). At 6 months of follow-up, of the 244 girls studied, those with severe anaemia decreased from 3% to 1%, with moderate anaemia from 97% to58% and the non-anaemic girls increased from 0% to 41%. Conclusion. Non-toxic nutritive food and safe water with fluoride level < 1.0 mg/L are useful in improving haemoglobin levels in a high percentage of anaemic schoolchildren. A haemoglobin level of > 12.0-14.4 g/dL is an achievable target in children without iron supplementation.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,433 519 -
Adopting ORCID as a unique identifier will benefit all involved in scholarly communication
Subbiah Arunachalam, Muthu Madhan
July-August 2016, 29(4):227-234
ORCID, the Open Researcher and Contributor ID, is a non- profit, community-driven effort to create and maintain a registry of unique researcher identifiers and a transparent method of linking research activities and outputs to these identifiers. Together with other persistent identifiers for scholarly works such as digital object identifiers (DOIs) and identifiers for organizations, ORCID makes research more discoverable. It helps ensure that one's grants, publications and outputs are correctly attributed. It helps the research community not just in aggregating publications, but in every stage of research, viz. publishing, reviewing, profiling, metrics, accessing and archiving. Funding agencies in Austria, Australia, Denmark, Portugal, Sweden and the UK, and the world's leading scholarly publishers and associations have integrated their systems with ORCID registry. Among the BRICS countries, China and South Africa are adopting ORCID avidly. India is yet to make a beginning. If research councils and funding agencies in India require researchers to adopt ORCID and link ORCID iDs to funding as well as tracking performance, it will help them keep track of the workflow. Journal editors can also keep track of contributions made by different authors and work assigned to different reviewers through their ORCID iDs
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,412 360 -
Single use versus reuse of endoscopy biopsy forceps: A survey of patient preference
Sandeep Davavala, Philip Abraham, Devendra Desai, Anand Joshi, Tarun Gupta, Hrishikesh Samant
July-August 2016, 29(4):205-206
Background. Although there are no confirmatory data on this, we suspect that most endoscopy centres in India reuse single-use ('disposable') endoscopic biopsy forceps due to the cost of these forceps and the perceived low risk of infection transmission on reuse. Low-cost single-use biopsy forceps are now available in India, bringing into question the justification for such a practice. We aimed to determine the type of forceps (single-use or reused) patients would prefer during endoscopy for themselves, whether this is dependent on cost, and what cost would be acceptable to them. Methods. Among patients (conveniently selected from indoor or outdoor) reporting for endoscopy at the division of gastroenterology at a private tertiary-level hospital, we distributed an information sheet about the survey 30-45 minutes before the procedure. After they completed reading the sheet, an endoscopy nurse and/or doctor explained the study. The patient then completed a questionnaire of multiple choices with tick boxes. Results. Of 151 patients approached, 4 declined to participate. Of 147 patients surveyed (age range 16-83 years; 82 men), 127 (86.4%) preferred single-use forceps, 16 (10.9%) preferred reused forceps, and 4 (2.7%) could not decide and left the decision to the physician. When informed that single-use forceps may be available for about ₹1000 (approximately US$ 15), 131 patients (89.1%) preferred these forceps, 11 (7.4%) preferred reused forceps, and 5 (3.4%) could not decide. Forty-four patients (33.1%) stated that an acceptable cost for a forceps for them would be ₹500 (approximately US$ 8), for 65 patients (48.9%) patients it was ₹1000, and for 24 (18.1%) it was ₹1500. Conclusion. About 90% of patients in this survey preferred single-use forceps; a cost of ₹1000 for single-use forceps was acceptable to over two-thirds of them.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,427 295 -
Trastuzumab and lapatinib in HER2-positive metastatic colorectal cancer
Bivas Biswas, Sameer Rastogi, Atul Batra, Sandip Ganguly
July-August 2016, 29(4):219-220
Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,197 519 -
Mortality among homeless women who remain unclaimed after death: An insight
Aayushi Garg, Chittaranjan Behera, Saurav Chopra, DN Bhardwaj
July-August 2016, 29(4):207-208
Background. Some homeless people remain unclaimed after death. Although women constitute a minor proportion among the homeless, they represent a more vulnerable section. We reviewed the major autopsy characteristics and causes of death among women whose bodies remained unclaimed after death. Methods. We analysed the autopsy records and inquest papers of unclaimed bodies of women for the period 2006-12 at the Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi. Results. Most women whose bodies were unclaimed were 21 to 60 years old with a mean age of 45 years. Natural events (53.5%), largely attributable to acute/chronic lung diseases, were identified as the most common cause of death. Accidental deaths were predominant among the unnatural causes. Most bodies of women were found on the footpath besides the road (56.1%). Conclusion. The problems of physical/sexual abuse, acute chest infections and road traffic accidents are all aggravated in the situation of homelessness. More affordable shelters are needed to preferentially accommodate women. Also, awareness about the existing medical facilities needs to be increased.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,413 283 -
Medical biochemistry: Is it time to change the teaching style?
Jeeji Palocaren, Lekha S Pillai, TM Celine
July-August 2016, 29(4):222-224
Background. The Medical Council of India (MCI) recommendations on medical education suggest a shift from didactic lectures to more interactive lectures. This study assessed the effectiveness of different pedagogical methods in biochemistry and the perceptions of students and teachers about the shift from didactic to interactive lectures. Methods. An interventional crossover study was done with the topic divided into three biochemical modules and one clinical module. The students were divided into two batches, one of which was given didactic and the other, interactive lectures. They were assessed immediately after the lecture and four months later. Anonymous feedback was obtained to gauge the students' perceptions regarding the mode of teaching. The teachers' feedback on the use of both pedagogical styles was also obtained. Results. There was no significant difference between the performance of the two groups in either examination in three of the modules. However, there was a statistically significant difference between the two groups' performance in the module that had clinical applications, with students from the interactive lecture group performing better. All students preferred interactive classes, irrespective of the topic taught. The teachers indicated that, although at the outset the interactive lectures were difficult to manage, both in terms of content and time, these drawbacks could be overcome with time and practice. Conclusion. Interactive lectures are an effective teaching method in biochemistry, especially in topics involving clinical application.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,326 260 -
The Opportunities to 'Beat Diabetes'
Yashdeep Gupta, Nikhil Tandon
July-August 2016, 29(4):189-191
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  1,297 215 -
Pituitary carcinoid coexisting with systemic lupus erythematosus: A rare combination
Anupam Bhambhani, Manish Dugar, Jyotsna Rao, Ravikanti Prasad
July-August 2016, 29(4):209-211
Gastrointestinal carcinoids have occasionally been reported in patients with autoimmune diseases. We report a middle-aged woman who presented with episodic hypertension and a skin rash. Initial evaluation led to the diagnosis of systemic lupus erythematosus for which the patient was treated. Further investigations revealed the presence of a carcinoid tumour in the pituitary. Although gastrointestinal carcinoids associated with autoimmune diseases have been seen occasionally, to our knowledge, extragastric carcinoid coexisting with an auto- immune disorder has never been reported before. A better understanding of how inflammation induces cytological changes leading to development of a carcinoid from a cellular and molecular perspective could provide potential therapeutic strategies for preventing these lesions.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  1,286 220 -
Medical marijuana laws and marijuana use in the USA: Any lessons?
Nishtha Chawla, Mamta Sood
July-August 2016, 29(4):220-221
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  1,149 337 -
Sagar Kabra: A doctor who strove to light the world
Brett Lewis
July-August 2016, 29(4):225-226
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  1,256 170 -
Letter from Chennai
MK Mani
July-August 2016, 29(4):235-236
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  1,190 134 -
Letter from Glasgow
Harpreet S Kohli
July-August 2016, 29(4):237-238
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  1,171 139 -
Book Reviews

July-August 2016, 29(4):240-244
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  1,127 142 -
Letter from Bristol
James E Bowler, Deeraj Rai
July-August 2016, 29(4):238-239
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  1,124 133 -
Half-and-half nails: An old sign revisited
Unnati Desai, Jyotsna M Joshi
July-August 2016, 29(4):245-245
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  396 255 -
Spinal metastases of glioblastoma multiforme in a patient with polyneuropathy
Leslaw W Zub, Marta Waliszewska-Prosól, Tomasz Szczepański, Zdzislaw Wo˙niak, Maria Ejma
July-August 2016, 29(4):246-246
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  442 194 -
Comparison of quantiferon gold and Mantoux test in adults with serpiginous-like choroiditis in northern India
Subijay Sinha, Rohan Chawla, Pradeep Venkatesh, Sat Pal Garg
July-August 2016, 29(4):247-247
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  371 229 -
Comment on 'Routine health check-ups'
Aditya Kapoor, Shiridhar Kashyap
July-August 2016, 29(4):247-248
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  360 162 -
News from here and there
PM Nischal
July-August 2016, 29(4):249-250
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  379 115 -
Health checkups: Boon or burden?-Authors'reply
Bianca S Honnekeri
July-August 2016, 29(4):248-248
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  343 132 -
Vivek Arya
July-August 2016, 29(4):251-251
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  366 103 -